The Impact of Probiotics on Clinical Outcomes in Diverticular Disease: A Systematic Review and Meta-Analysis

Background/Objectives: Diverticular disease (DD) affects a significant portion of the aging population and is increasingly linked to gut microbiota alterations. Probiotics have emerged as a potential adjunct therapy, particularly in managing symptoms and inflammation. The evidence for the recommended use of probiotics in clinical practice for management of diverticular disease is still a matter of controversy. Methods: A comprehensive literature search was conducted across five major databases up to October 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies assessing probiotic use in adult patients with diverticular disease. Results: Thirteen studies met the eligibility criteria. Probiotic therapy was associated with improvement in abdominal pain (SMD 0.63; 95% CI: 0.38-0.88). For bloating, probiotics demonstrated a small trend toward improvement (SMD 0.158; 95% CI: -0.107 to 0.422), although this did not reach statistical significance. C-reactive protein (CRP) outcomes were reported in three studies conducted in acute uncomplicated diverticulitis. All showed reductions in CRP following probiotic therapy; however, substantial variability in baseline levels and assessment timepoints prevented a reliable pooled estimate, and findings were summarized descriptively. Long-term outcomes from two RCTs showed a reduced risk of recurrence (RR 0.22; 95% CI: 0.095-0.510), with multi-strain and longer-duration regimens appearing more beneficial. Conclusions: Probiotics, particularly multi strain formulations administered over longer durations, may help improve symptoms and reduce inflammatory activity in diverticular disease; however, the certainty of evidence remains low to very low due to heterogeneity and methodological limitations. Larger, high-quality randomized trials are needed to clarify the long-term clinical impact of probiotic therapy.